Opportunities and Challenges to Advance Health Equity Using Digital Health Tools in Underserved Communities in...

Area of Science:

• Health Services Research
• Digital Health
• Health Equity

Background:

• Health information technology and digital health tools (DHTs) have improved US healthcare access over 30 years, especially for rural and underserved populations.
• Despite widespread adoption by primary care clinicians, challenges persist, leading to inequitable use and benefits.
• The COVID-19 pandemic accelerated DHT adoption due to policy changes and patient needs.

Purpose of the Study:

• To assess the adoption and use of DHTs by primary care clinicians in southeastern states.
• To identify individual- and practice-level barriers and facilitators to DHT implementation.
• To understand the impact of DHTs on healthcare access and health disparities.

Main Methods:

• A mixed-methods approach combining surveys and focus groups.
• Surveys utilized a multi-modal recruitment strategy reaching 1215 primary care clinicians.
• Focus groups (n=25) explored priorities, barriers, and facilitators, with thematic analysis of transcripts.

Main Results:

• Nearly all clinicians (99%) used DHTs in the past 5 years, with telehealth and EHRs being most common.
• Key barriers included time (53%) and cost (51%).
• Clinicians reported high satisfaction with telemedicine (61%) and EHRs (75%). COVID-19 and supplemental tools motivated adoption, but HIE interface issues and patient connectivity challenges were noted.

Conclusions:

• DHT adoption by primary care clinicians expands healthcare access and can reduce health disparities in inequitable regions.
• Findings highlight opportunities to leverage DHTs for advancing health equity.
• Policy improvements are needed to address implementation challenges and enhance equitable DHT benefits.